“First Nation Healthcare
coverage, and who pays for it...”
FEBRUARY 10, 2011 10:30 – 12:00PM
Cambridge Room
Clifford Cardinal
Assistant Professor
Department of Family Medicine
These may be the ones who may be dealing
with this issue at the time health coverage
becomes a major issue.
4th year medical students during Community Health 515
Potential reduction in access to appropriate
funded and responsive primary health care for
the First Nations People in Canada.
• Early institutionalized contact policies (pre 1860) recognized First Nations
as foreign to the Crown thereby supporting the right to conquer and rule
them.
• In Post Confederation protective paternalistic policies (1860 – 1920) saw
the establishment of the Reserve System and Adoption of the Indian Act
1867.
• Policies followed paternalism and saw the growth of Residential Schools
(1920 – 1996) which had the First Nations losing language, culture and
identity as well as pandemics of the times which saw the loss of many
Indians. Hospitals were build.
• Parallel health institutions created Federal Gov’t, after this it period was
thought that preferential treatment was given to First Nations, and
therefore hospitals were closed as were other community health centers
(1985 Indian Act) and in the eyes of many Canadians undeserving of such
opportunities (Newhouse, 2004).
IIm!
• Women who married non-Indians lost their treaty rights up until
1985 when Bill C-31 was legislated across Canada. These women
and their male children health care was restored. When their Rights
were restored, the influx resulted in new Band Members, some as
much as 1/3rd was added on to their memberships but with no raise
in the Capital Spending for Health Care. Mention difference : Indians; who never lost their Rights.
Registered Indians; after 1985 Bill C-31 of Children of women who gained rights. Non-Status; ineligible children.
• This dramatic increase in population and entitlement offered in onReserve communities as a result of Bill C-31 was never met with an
adjustment in health costs, budgets and services, (Lavoie et al
2005;2007). (Will repeat this as time goes by to emphasize)
• Other Benefits and Services such as eye glasses, medication,
medical transport, and dental care provided under the Non- Insured
Health Benefits (NIHB) and applies uniquely to registered Indians
living in on-Reserve communities.
.
• Complex issue of defining Indian Status; include who is living on
reserve and off reserve for funding of their primary health care
needs. Non-status implying, an ineligible “Indian for Registration”
and may be resultant from; children/offspring on waiting list as
applicants still need someone to confirm heritage and blood
lineage. Many are denied. Many are still waiting approvals. Many
are simply at the mercy of Chiefs and Councils.
• Funding for primary health care does not include reserve residents
who are not eligible for registration under the Indian Act of 1867.
The Policy assumes that those individuals will travel to provincial
health care facilities. Therefore the large numbers coming to cities.
Although they are Indians in blood, they may be not-registered in
any Bands. It is the duty of the Mother to Register their babies after
delivery, more than 1/3rd are not registered or waiting to be reg’d.
.
• Funding arrangements for status First Nations people reveal the
following: First Nation and Inuit Health Branch (FNIHB) has primary
responsibilities to fund all reserve services. NIHB has extended its
responsibilities to off-reserve Status Indians. Indian and Northern
Affairs Canada (INAC) provides limited responsibilities in the area of
infrastructure and long-term care. Alberta Health and Wellness is
responsible for acute care costs and physician services for the entire
population through prov. insured health benefits. Public Health also
offers services for off-reserve Indians, but is not targeted
specifically for First Nations but to vulnerable populations such as
Newly Arrived Immigrants'.
• Cultural damage as to who is an Indian and who is not an Indian,
and ultimately loss of status of so many woman and children who
are no longer recognized—and in many cases, no longer identify—
as Indians is incalculable.
1. When individuals do find their way to off-reserve healthcare, however, research
shows that tacit and overt discriminatory practices and policies continue to
marginalize many First nation individuals in the mainstream health care system
(Browne, 2005; 2007; Tang and Browne, 2008; Varcoe and Dick, 2008).
2. Negative healthcare experiences stem from encounters with a health care system
that tend to reflect dominant discourses about First nations people as relatively
irresponsible, dependent, and in some cases undeserving of health care, reflecting
persistent stereotypes and misinformed assumptions.
3. Federal Gov’t has so far failed to align funding with population growth.
4. It is unlikely that FNIHB will expand the scope of its coverage's to include those
individuals that will be eligible for registration (Bill C-3) for reasons unknown.
However, since 1994, FNIHB policy has been to “get out” of business of providing
direct health services delivery (Health Canada[MSB], 1995.
5. First Nations who manage their health services have inherited budgets locked at the
level of historical expenditures in place when they signed their first agreements, with
limited provision for population growth.
6. Onus is placed on First Nations to redress and promote the health of communities,
despite the lack of funding available for health promotions. Meaning they are telling
First Nation people to get well themselves, don’t get sick, we will however fund
pandemics (Public Health Agency of Canada). (et al Pimatisiwin, Journal of Aboriginal and Indigenous
Community Health 8(1). 2010. p.91)
1. First Nations who have never lost their Indian status are registered
as “Indians” under the Indian Act article 6(1). Those who lost
status by marriage or other discriminatory (living off-reserve,
gaining meaningful employment, attaining Gr. 12, having money in
Bank...) means prior to 1985 are eligible for registration under the
Indian Act 6(2). Both 6(1) and 6(2) classifications categories imply
full status and benefits. They become “Status Indians”. Indians who
have neither parent who was an Indian under the Indian Act are
“non-Status Indians or unregistered Indians” who receive no
Federal health care benefits.
2. Today if an Indian lives off-Reserve they become ineligible for
healthcare benefits and fall under provincial care.
3. For First Nations, the Treaties were understood as an exercise of
self – preservation, in light of the American Indian Wars, demise of
Bison, and devastating impacts of the epidemics of 1885 – 1927.
KEY POINTS
• Over 1/3 of current prescription are not funded by past
obligations that Federal Government had with First
Nations’ People under Treaty.
• Attempts to address the inequalities experienced by Firs
Nations creates barriers to accessing primary health care
on reserve, result in increased secondary and tertiary care
and increased financial burden on Provincial health care
budgets.
• Current policies as designed, promote the disintegration
of First Nation communities and will result in increased
social inequities and unmet health care needs of Treaty
Indians. In Edmonton there are 22,440 of the 689,025
“Indians” in Canada.